L5-S1 Discectomy Recovery Question

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nyquist
Participant

July 26, 2021 at 10:57 am

Post count: 4

#34208

Hello,

I want to thank you for this amazing resource. I love that you explain things rather than just say “let the pain be your guide” and “it takes time.” I am desperate to better understand my recovery as I feel like I am in the dark right now.

I am 5 months post-op from an L5-S1 discectomy. I had pretty terrible sciatica down my right side and the right side of my foot was completely numb. All told I had the sciatica for close to a year.

While the numbness in my foot went away a few days post op, the sciatic pain stuck around and continued to get worse. In a fit of desperation 3 weeks post op I went to my chiropractor who gently adjusted my hip. I had an instant relief in the pain, I nearly wept. The pain would return, although to a lesser degree. I was getting twice-weekly adjustments to my hip, but now it is once every other week or so.

Since then I have had a slow recovery. The really bad sciatica pain went away about 3 months post-op. Currently I still have stabbing pains in my buttock and hamstring area and my hamstring,calf and right hip get super tight. But, the thing that really makes me nuts is that it is random. I’ll have hours when my leg feels normal, and then suddenly there is pain and severe tightness, then it gets a little better, and then I’ll have days with more pain. I can’t seem to find any pattern to it.

I have found that Motrin definitely eases the pain and I think it helps with the tightness some too. I am doing PT once a week plus I do most of the exercises at home daily. I do ~30 minutes of walking daily and I get cardio by doing a fitness app in VR that is mostly hand motions.

So, I guess my questions are:
1) Is it normal to still have these inflammation related symptoms 5 months post op?
2) Is the tightness and pain coming from the nerve root itself do you think or is it possible I’ve got some piriformous issues or something else?
3) Do you have any theories on why I needed that adjustment from the chiropractor to get relief post-op?
4) Is there anything else I should be doing to help my recovery along?

If you have time to answer, I will genuinely appreciate it. I hope you have a great day.

-Jack

Donald Corenman, MD, DC
Moderator

July 26, 2021 at 2:20 pm

Post count: 8660

#34210

Is it normal to still have these inflammation related symptoms 5 months post op? It is not normal to have more intense significant symptoms 5 months post-op. You did however wait a full year before surgery so recovery will be much slower than normal. Did you have a new post-op MRI to determine your current status.

Is the tightness and pain coming from the nerve root itself do you think or is it possible I’ve got some piriformous issues or something else? Most likely, the pain is generated by the inflamed nerve root. The reason we recommend surgery more rapidly is that constant chronic compression of the root can cause further damage to the root, sometimes causing chronic radiculopathy See: https://neckandback.com/conditions/chronic-radiculopathy/

Do you have any theories on why I needed that adjustment from the chiropractor to get relief post-op?
That is interesting and an uncommon (but obviously welcome) result from a manipulation. I can’t understand why.

Is there anything else I should be doing to help my recovery along? I would recommend a new MRI to make sure the root is decompressed and if it is, an epidural steroid injection (TFESI) See: https://neckandback.com/treatments/epidural-injections-and-selective-nerve-root-blocks-diagnostic-and-therapeutic/

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

nyquist
Participant

July 27, 2021 at 9:25 am

Post count: 4

#34215

Thank you so much for getting back to me.

Is it possible that the epidural steroid injection would help the nerve recover or is it something I’d likely need to keep getting for life?

My surgeon wants me to wait until 6 months post op before he sees me and considers another MRI. I am (im)patiently waiting.

Luckily my pain is significantly better than pre-op, and in general it is more of an annoyance than anything like the nightmare sciatica. It doesn’t usually stop me from doing day-to-day things, but it does get tiring. I know this is hard to answer, but would you say it is still possible that I will see further improvements in pain at this point provided there isn’t a new compression?

Donald Corenman, MD, DC
Moderator

July 27, 2021 at 11:01 am

Post count: 8660

#34217

Steroid injections can yield temporary relief or even permanent relief. I am glad to hear you are significantly better. It seems reasonable to wait but if your symptoms increase, a new MRI is a good idea.

Dr, Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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